Update to the International Meeting on Emerging Diseases and Surveillance (IMED) community on the latest activities for the BioSense Program redesign and public health syndromic surveillance (PHSS) meaningful use objective.

1. Novel Approaches in Public Health Surveillance
BioSense Program Redesign, Meaningful Use, and Syndromic Surveillance
International Meeting on Emerging Diseases and Surveillance (IMED)
Session 13: New Surveillance Strategies
Sunday, February 6, 2011: 8:30-10:30 AM
Vienna, Austria – February 4-7, 2011
Taha A. Kass-Hout, MD, MS
Deputy Director for Information Science (Acting) and BioSense Program Manager
Division of Notifiable Diseases and Healthcare Information (DNDHI)
Public Health Surveillance Program Office (PHSPO)
Office of Surveillance, Epidemiology, and Laboratory Services (OSELS)
Centers for Disease Control & Prevention (CDC)
Any views or opinions expressed here do not necessarily represent the views of the CDC, HHS, or any other entity of the United States
government. Furthermore, the use of any product names, trade names, images, or commercial sources is for identification purposes only,
and does not imply endorsement or government sanction by the U.S. Department of Health and Human Services.
Public Health Surveillance Program Office
Office of Surveillance, Epidemiology, and Laboratory Services

2. The Public Health Surveillance Challenge
 Surveillance is a global  Limitations of
challenge that knows traditional reporting
no borders systems
 The importance of  Hierarchical lines of
timely detection reporting
 Variance across different
countries
 Multitude of potential
data sources
 Real-world lessons
from SARS and H1N1

3. A Global Challenge
n=398
WHO reported outbreaks, 1996-2009

4. Next Generation Public Health Surveillance
Automated Healthcare data and informal sources,
Community Engagement, and Artificial Intelligence
Informal sources
Automated healthcare data
(laboratory, immunization,
notifiable conditions, syndromic,
personal health records, …)

5. Limitations of Current Approaches
 Can’t mine
 all possible sources
 all data types
 Delay required for searching,
curating and processing
 Massive bandwidth and
processing requirements
 Resource limited process
(machine and human)
 Policies that hinder data
sharing
 Little sharing of standards,
“Federal agencies must focus on consolidating existing data
specifications, and lessons centers, reducing the need for infrastructure growth by
learned implementing a “Cloud First” policy for services, and
increasing their use of available cloud and shared services.”
Vivek Kundra, Fed CIO.

6. The Opportunity in MUse: Support Case- and
Event-Based Surveillance

7. EHRs and Health Information Exchanges can
Improve Public Health Surveillance
 Enhanced Situation Awareness
 Syndromic surveillance exploits more elements from the EHR for earlier characterization
• can limit spread of outbreak or monitor severity of pandemics, and reduce morbidity and mortality
 Automated collection and reporting encourages more care provider organizations to participate
 Timely and More Complete Notifiable Disease Reporting
 Studies have shown that electronically based reporting for STDs averages 7.9 days earlier than
spontaneous reporting, allowing:
• 52% increase in treating patients in 2 weeks
• 28% increase in reaching at risk subject by phone
 Automation of this task is popular with healthcare provides since it relieves a perceived burden
 Better Prevention and Surveillance or Chronic Conditions
 Addresses major factors in rising healthcare costs
 Data can be used for outcome-based incentives for best practices
 Simple ABCDs (Aspirin Therapy, Blood Pressure Screening, Cholesterol Screening, Smoking Cessation, and
Diabetes) Interventions can reduce the number of avoidable deaths
• CDC’s Demonstrating the Preventive Care Value of HIEs (DPCVCHIE) project is using national standards and
capabilities to evaluate the effectiveness of ABCDs interventions
Consistency of Reporting
Reduced Latency
More Completeness of Reporting

8. Example 1: The Distribute Project
 President’s Council of Advisors
on Science and Technology
recommended expanded use of
Emergency Department SS data
 New CDC Director accustomed to
daily use of ED SS data for
influenza and other situation
awareness in NYC
 CDC funded and worked
collaboratively with the Public
Health Informatics Institute
(PHII) to support rapid scale-up
of ISDS Distribute project
Public-access site: http://isdsdistribute.org

9. Distribute: Philosophy
Public-access site: http://isdsdistribute.org

10. Distribute: System
 Participating Sites (39)
 State (26, 67%)
 Sub-State (8, 21%)
 City (5, 13%)
 ~67.5 million ED visits
(>140,000 visits/day)
from April 1, 2009 thru
Feb 1, 2010
Buckeridge DL, Brownstein JS, Lober WB, Olson DR, Paladini M, Ross D, Finelli L, Kass-Hout TA, Buehler JW. 2011. The
Distribute Project: Rapid Sharing of Emergency-Department Surveillance Data During the Influenza A/H1N1 Pandemic. In Review.

11. Distribute: Outcome
Buckeridge DL, Brownstein JS, Lober WB, Olson DR, Paladini M, Ross D, Finelli L, Kass-Hout TA, Buehler JW. 2011. The
Distribute Project: Rapid Sharing of Emergency-Department Surveillance Data During the Influenza A/H1N1 Pandemic. In Review.

12. Example 2: BioSense Program
Civilian Hospitals
• ~640 facilities [~12% ED coverage in US, patchy geo
coverage] [Chief complaints: median 24-hour
latency, Diagnoses: median 6 days latency]
• 8 health department sending data from 482
hospitals
• 165 facilities reporting ED data directly to CDC
or a health department
Veterans Affairs and Department of Defense
• ~1400 facilities in 50 states, District of Columbia, and
Puerto Rico [final diagnosis ~2->5 days latency]
National Labs [LabCorp and Quest]
• 47 states, the District of Columbia, and Puerto Rico
[24-hour latency]
Hospital Labs
• 49 hospital labs in 17 states/jurisdictions [24-hours
latency]
Pharmacies
• 50,000 (27,000 Active) in 50 states [24-hour latency]

13. BioSense Program Redesign
Updated Vision: Beyond early detection Beyond syndromic
 The goal of the redesign effort is to be able to provide
 Nationwide and regional Situation Awareness for all hazards health-related
events (beyond bioterrorism) and to support national, state, and local responses
to those events
 Multiple uses to support your public health Situation Awareness; routine public
health practice; and improved health outcomes and public health
 Our strategy is to increase BioSense Program participation and
utility and to support local and state jurisdictions’ health
monitoring infrastructure and workforce capacity
 Requires collaboration with other CDC Programs and federal agencies
– 7 years of experience dealing with timely healthcare data (Outpatient, ED, Inpatient, Census,
Laboratory, Radiology, Pharmacy, etc.)
– Infrastructure reconfigured for high performance, scalability and Meaningful Use (MUse)

14. BioSense Program Redesign
A 3-Pronged Approach
Building Connecting Sharing
the Base the Dots Information
A User-Centered Approach

15. Technical Expert Panel (TEP)—Current Status
 David Buckeridge  Judy Murphy
 McGill University  Aurora Health System
 Julia Gunn  Marc Paladini
 National Association of County  NYC Department of Health
and City Health Officials and Mental Hygiene
(NACCHO)  Tom Safranek, Lisa Ferland,
 Jim Kirkwood Richard Hopkins
 Association of State and  Council of State and Territorial
Territorial Health Officers Epidemiologists (CSTE)
(ASTHO)
 Walter G. Suarez
 Denise Love  Kaiser Permanente
 National Association of Health
Data Organizations (NAHDO)

16. BioSense Program Redesign
Selected Collaborations
 Gulf Oil Spill-associated surveillance
 AL, FL, LA, MS, TX, NCEH, CDC EOC+
 Dengue case detection
 Dengue Branch, FL Dept of Health, VA
 State-based asthma surveillance
 AL Dept of Health, VA, DoD
 Non-acute dental conditions
 Division of Oral Health, NC DoH, NCDetect
 Rabies post-exposure prophylaxis
 Poxvirus & Rabies Branch
 Influenza-like illness surveillance
 Influenza Division
 Contribution to Distribute
 ISDS
 MUse Workgroup
 Enhanced analytics methods
https://sites.google.com/site/changepointanalysis

17. BioSense Program Redesign
Selected Stakeholders

18. BioSense Program Redesign
Stakeholder Involvement
 Seeking individuals from
professional
organizations to
participate in redesign
effort
 Coordinating presence at Coverage Map
national conferences
 Identifying individuals to
update the map on the Requirements Gathering
collaboration site
 Disseminating redesign
project information Community Forum
through communication
channels
http://biosenseredesign.org

19. Environmental Scan
The purpose of the environmental scan is to assess current best
practices in surveillance and extract from them requirements to
aid in the BioSense Redesign
Note: The map has been initially populated with public health
jurisdictions' self-reported data obtained through Distribute

20. BioSense Program Redesign
Stakeholder Involvement
September 1st thru January 17th 2011

21. HDs Readiness for SS MUse
 Many State or Community Health Agencies are not
yet prepared to receive the new wave of EHR data
 According to TFAH, ASTHO and BioSense Program redesign
ASTHO’s MUSe Readiness Survey, # of States and Territories Responding = 35

22. Stakeholder Input: Summary Hospital
3%
 The BioSense Redesign Collaboration Site has been visited State
by a broad range of public health stakeholders from all 43%
jurisdiction levels Local
51%
 Most (87%) felt there is value in viewing a regional or national
surveillance picture
National
 Value in the BioSense Network 3%
 Data sharing across jurisdictions is the most common data analysis requested
 The value provided by BioSense is focused on identifying and tracking outbreaks and
understanding disease transmission patterns
 While preferences for presenting information changes little during a public health event, the
types of data required do change
 Many syndromes or conditions (including bioterrorism-related) need to be captured to
support PH situation awareness
 Barriers
 There are many barriers to data sharing, including the lack of established policies and
agreements
 Lack of funding and workforce deficiencies are the most common infrastructure needs
 Lack of tools, skills, and time account for all barriers related to data analysis
Source: Feedback Forum Posts 1-3, Available under “Your Requirements” at: https://sites.google.com/site/biosenseredesign
Total Number of Respondents = 39; September 1 – November 12, 2010

23. Core Processes and EHR Reqs for PH SS
 Data Sources Data on emergency
department (ED) and urgent care (UC)
patient visits captured by health
information system and sent to a
public health authority defines the
scope of this recommendation
 Surveillance Goal Assessment of
community and population health for
all hazards defines the scope of this
recommendation
 Message and Vocabulary Standards
Standards that support current and
continued PHSS improvements, while
maintaining consistency with those
standards required by the CMS EHR
Reimbursement Program define the
scope of this recommendation
ISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use

24. Core Processes and EHR Reqs for PH SS:
Consensus-Driven Development
ISDS MUse Workgroup informed 41 stakeholders commented; ~ 20%
early iterations. Stakeholder input corporations or professional
validated, refined and better organizations
contextualized the 4 EP or Hospital
recommendations. 9 Vendors
20 Public Health
2 Other

25. Core Processes and EHR Reqs for PH SS:
32 Recommended Elements
ISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use

26. Core Processes and EHR Reqs for PH SS:
32 Recommended Elements
ISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use

27. Core Processes and EHR Reqs for PH SS:
32 Recommended Elements
ISDS MUse Workgroup: http://syndromic.org/projects/meaningful-use

28. Acknowledgements
 US CDC  TEP Members
 James Buehler*, Samuel
Groseclose*, Laura Conn*, Seth  David Buckeridge*, Julia Gunn,
Foldy*, Nedra Garrett* Jim Kirkwood, Denise Love, Judy
Murphy, Marc Paladini, Tom
Safranek, Lisa Ferland, Richard
 RTI International
Hopkins, Walter Suarez
 Barbara Massoudi*, Lucia Rojas-
Smith, S. Cornelia Kaydos-
Daniels, Annette Casoglos, Rita
Sembajwe, Dean Jackman, Ross  ISDS
Loomis, Alan O'Connor, Taya  Charlie Ishikawa*, Anne Gifford,
McMillan, Amanda Flynn, Tonya
Farris, Alison Banger, Robert Rachel Viola, Emily Cain
Furberg
 Epidemico
 John Brownstein*, Clark Freifeld,
Deanna Aho, Nabarun Dasgupta,
Susan Aman, Katelynn O'Brien
* Co-authors

29. Thank You!
BioSense Redesign ISDS MUse Workgroup
http://biosenseredesign.org http://syndromic.org/projects/meaningful-use
biosense.redesign2010 AT gmail DOT com
Any views or opinions expressed here do not necessarily represent the views of the CDC, HHS, or any other entity of the United States
government. Furthermore, the use of any product names, trade names, images, or commercial sources is for identification purposes only,
and does not imply endorsement or government sanction by the U.S. Department of Health and Human Services.